Rupture-oriented strategy for acute type A aortic dissection

Kuznetsov DV, Semagin AP, Zybin AA, Gevorgyan AA, Polyaeva MV, Sidorenko NN, Khokhlunov SM. Rupture-oriented strategy for acute type A aortic dissection. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(1):56‑62. (In Russ., In Engl.)
https://doi.org/10.17116/kardio20241701156

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the immediate and long-term results of surgical treatment of acute aortic dissection type A using rupture-oriented strategy.

MATERIAL AND METHODS

A prospective study included 157 patients with acute aortic dissection type A who were divided into 2 groups: group 1 — 123 people (inner wall rupture in ascending aorta or lesser curvature of aortic arch) underwent ascending aorta replacement and, if necessary, hemiarch procedure, group 2 — 34 patients (inner wall rupture in aortic arch (except for lesser curvature) or no rupture in ascending aorta and aortic arch, aortic arch aneurysm) underwent ascending aorta and aortic arch replacement. Early and late postoperative results were assessed.

RESULTS

In-hospital mortality was similar (13.8% and 14.7%, respectively, p=0.9). Early postoperative morbidity (bleeding, myocardial infarction, neurological complications, acute renal failure) was similar. Five-year survival rate was 74% and 82%, respectively (p=0.97), five-year freedom from redo aortic surgery — 88% and 90%, respectively (p=0.75).

CONCLUSION

Rupture-oriented surgical strategy for acute aortic dissection type A may be used without worsening immediate and long-term results, especially in hospitals without extensive experience in aortic surgery.

Keywords:

aortic dissection

ascending aorta replacement

aortic arch replacement

Authors:

Kuznetsov D.V.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0003-4843-4679

Semagin A.P.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0003-2945-894X

Zybin A.A.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0001-8985-5723

Gevorgyan A.A.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0003-0730-4608

Polyaeva M.V.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0003-3305-5318

Sidorenko N.N.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0003-2538-3573

Khokhlunov S.M.

Polyakov Regional Clinical Cardiology Dispensary

ORCID: 0000-0001-6000-620X

Received:

31.08.2022

Accepted:

21.10.2022

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References:

Charchyan ER, Belov YuV, Stepanenko AB, Gens AP, Fedulova SV, Nikonov RYu. Valve-sparing surgery for type A aortic dissection with aortic insufficiency. Cardiology. 2014;54(6):91-96. (In Russ.).
Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149:S91-98.
Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2008;136:1160-1166.
Zierer A, Voeller RK, Hill KE, Kouchoukos NT, Damiano Jr RJ, Moon MR. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg. 2007;84:479-486.
Coselli JS. Acute ascending aortic dissection: support for limited distal repair. Thoracic and cardiovascular surgery. 2014;148(5):2123-2124. https://doi.org/10.1016/j.jtcvs.2014.09.069
Kyaw Ko Ko Latt, Vasiliev K.N., Bayandin N.L. Surgical treatment of acute aortic dissection Stanford type A. Cardiology and Cardiovascular Surgery. 2018;11(5):90-95. (In Russ.). https://doi.org/10.17116/kardio20181105190
Uchida N, Shibamura H, Katayama A, Shimada N, Sutoh M, Ishihara H. Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg. 2009;87:773-777
Takahara Y, Sudo Y, Mogi K, Nakayama M, Sakurai M. Total aortic arch grafting for acute type A dissection: analysis of residual false lumen. Ann Thorac Surg. 2002;73:450-454.
Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, et al. Extended total arch replacement for acute type a aortic dissection: experience with seventy patients. J Thorac Cardiovasc Surg. 2000;119:558-565.
Urbanski PP, Siebel A, Zacher M, Hacker RW. Is extended aortic replacement in acute type A dissection justifiable? Ann Thorac Surg. 2003;75:525-529.
Patel P, Dong A, Chiou E, Wei J, Binongo J, Leshnower B, Chen E Aortic Arch Management During Acute and Subacute Type A Aortic Syndromes. Ann Thorac Surg. 2022;114:694-701. https://doi.org/10.1016/j.athoracsur.2021.12.064
Boening A, Karck M, Conzelmann L O, Easo J, Krüger T, Rylski B, Weigang E German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives. Thorac Cardiovasc Surg. 2017;65(2):77-84. https://doi.org/10.1055/s-0036-1572436
Hagan PG, Nienaber GhA, Isselbacher EM, et al The International Registry of Acute Aortic Dissection (IRAD)New Insights Into an Old Disease. JAMA. 2000;283(7):897-903. https://doi.org/10.1001/jama.283.7.897
Cartier A, Dagenais F J Commentary: Hemiarch replacement for acute type A dissection: Are we doing enough? Thorac Cardiovasc Surg. 2021;161:888-889. https://doi.org/10.1016/j.jtcvs.2020.11.039
Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg. 2002;73:707-713.
Shiono M, Hata M, Sezai A, Niino T, Yagi S, Negishi N. Validity of a limited ascending and hemiarch replacement for acute type A aortic dissection. Ann Thorac Surg. 2006;82:1665-1669.
Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, et al. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg. 2015;151:341-348.
Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffman I, Blettner M, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2016;49:e44-52.
Tanaka M, Kimura N, Yamaguchi A, Adachi H. In-hospital and long-term results of surgery for acute type A aortic dissection: 243 consecutive patients. Ann Thorac Cardiovasc Surg. 2012;18:18-23.
Shi Sum Poon, Thomas Theologou, Deborah Harrington, Manoj Kuduvalli, Aung Oo, Mark Field. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(3):156-173. https://doi.org/10.21037/acs.2016.05.06
Belov YuV, Charchyan ER, Khachatryan ZR. Total aortic dissection: what to do? M.: Publishing House «Media Sphere»; 2019;128. (In Russ.).
Yan Y, Xu L, Zhang H, Xu ZY, Ding XY, Wang SW, et al. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis. Eur J Cardiothorac Surg. 2016;49(5):1392-1401. https://doi.org/10.1093/ejcts/ezv351
Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg. 2014;148:949-954.
Luciani N, De Geest R, Lauria G, Farina P, Luciani M, Glieca F, et al. Late reoperations after acute aortic dissection repair: singlecenter experience. Asian Cardiovasc Thorac Ann. 2015;23:787-794.
Belov YuV, Stepanenko AB, Gens AP, Charchyan ER, Savichev DD. Simultaneous interventions on ascending aorta, aortic arch and heart valves in patients with Marfan syndrome. Angiology and vascular surgery. 2007;13(4):126-131. (In Russ.).